Wednesday, June 5, 2013

Michael Douglas, HPV, and Throat Cancer

Before the Angelina Jolie mastectomy stories have even faded from the pages of People magazine, a celebrity once again has brought cancer into the headlines. It would be hard to miss this story this week, but in case you have: Actor Michael Douglas, while promoting his new biopic about the flamboyant pianist Liberace, allegedly told The Guardian of London that his 2010 neck and throat cancer was caused by the human papilloma virus (HPV). The HPV, he allegedly said, was caused by oral sex of the kind that a man performs on a woman.

Douglas’ comment brought all kinds of publicity to him and to his movie Behind the Candelabra, but perhaps not exactly as he would have wanted. The remark went viral on the Internet. Then Douglas’ ex-wife, to whom he was married from 1977 to 2000 made a statement the he didn’t get the virus from her. Douglas backtracked, claiming he’d been misunderstood. So The Guardian released the audio recording of the interview.

Like Angelina Jolie’s mastectomy, the best thing you can say about Michael Douglas’ HPV comment is that it got us all talking.

Here are some of the main things to know:

• HPV is incredibly common. About 85 percent of us will be infected by it at some point during our lives; approximately 20 million are actively infected at any one time. Usually, we fight it off. But in a few cases, it will progress and cause a cancerous lesion.

• Docs used to think that the biggest danger from HPV was cervical cancer. That’s why we women get Pap smears. But in recent years, HPV has been shown to cause more neck and throat cancers than smoking.

• Yes, oral sex is one way that HPV might move from one person to another. But there’s not a straight line from oral sex to cancer. (This is the main substance of Michael Douglas’ backtracking.) Just because you’re HPV positive doesn’t mean you’re going to get cancer, but it does raise your risk.

• HPV-related cancers of the neck and throat are six times more likely to occur in men than in women.

• The typical neck and throat cancer patient used to be a drinker and a smoker. That’s no longer true. HPV-related oral cancers are on the rise.

• Currently, doctors don’t have a way to screen for oral HPV. But watch out if you have any of these symptoms: hoarseness, a sore throat that persists, pain or difficulty swallowing or chewing, mouth sores that don’t heal, a lump in the neck.

• If you do contract a cancer of the head or neck, that cancer may be easier to treat if you’re HPV positive.

Mount Sinai Medical Center in Manhattan has created this awesome infographic about HPV and head and neck cancers. WebMD has a write-up here. You can check out the Centers for Disease Control (CDC)’s FAQ here. There’s an award-winning piece in the cancer magazine, Cure, here.

Cancer patients know more than most people how hard it is to determine exactly what prevents cancer, beyond the usual “eat right, exercise, don’t smoke” exhortations. Yet here’s one thing we can absolutely do to prevent cancer: The CDC recommends the HPV vaccines.

Yes, sometimes vaccines cause side effects. The Centers for Disease Control (CDC) lists them here. But 90 percent of the time, the problems remain mild (fevers, soreness). Really serious side effects like brain swelling or pneumonia usually affect 1 percent or less of those who receive vaccines. As the CDC says in its statement about the Hepatitis A vaccine, it’s “the vaccine is much safer than getting the disease.”

Vaccines have been controversial since the first vaccine, for small pox, was introduced in the late 1700s. I can understand the fears about side effects; I have a dear friend who has had three heart attacks because of a medication interaction. But the most serious popular notions about vaccines, such as the idea that some of them can cause autism, have been disproved again and again. Remember: vaccines are given to prevent diseases that used to kill people in the tens of millions.

As a cancer survivor, I can’t imagine passing on a vaccine that might prevent cancer. Would you wish the harrowing experience of cancer treatment on anyone? Alas, in the United States, despite the CDC recommendation that both girls and boys get the HPV vaccine, only about 35 percent of girls 13 to 17 have received a full course of the shots. Part of this reluctance, I think, is that HPV involves that hot button issue of sex. Parents don’t want to think about the future sex life of their tweens and teens. A study published this spring says that 44 percent of parents don’t intend to vaccinate for HPV, up from 40 percent in 2008.

I can’t tell you how sad this makes me. Giving the HPV vaccine just protects kids; it doesn’t condone or cause promiscuity. How many boys and girls are going to grow up and get cervical, throat or neck cancer because they didn’t take advantage of this simple preventive measure?

My own daughter is 12. She got her first HPV shot in April, and gets the first of two booster shots next week. I can’t protect my kid from all the nasty things in the world, but I can protect her from this one danger. For me, it’s a no-brainer. What about you?

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Contributors

Wendy Baer, MD

Wendy Baer, MD, is the medical director of psychiatric oncology at the Winship Cancer Institute of Emory University in Atlanta. Dr. Baer helps patients and their families deal with the stress of receiving a cancer diagnosis and going through treatment. Her expertise in treating clinical depression and anxiety helps people manage emotions, behaviors and relationships during difficult times.

Heather Millar

Heather Millar is an award-winning freelance writer and author. In her blog My Left Breast, she details her treatment for breast cancer as well as the science, history, and ethics of the disease.